Trends in Use and Outcomes of Laparoscopic vs Robotic Cholecystectomy Based on BMI: A Statewide Analysis

BACKGROUND: Robotic surgery may mitigate technical challenges associated with patient obesity. However, prevalence of robotic cholecystectomy and impact on outcomes in patients with obesity are unclear. We evaluated trends in robotic cholecystectomy, factors contributing to robot use, and outcomes based on BMI. STUDY DESIGN: We analyzed data from a statewide, 69-hospital member clinical registry and identified patients who underwent elective robotic or laparoscopic cholecystectomy from 2020 to 2024. Patients were stratified by BMI (lower than 35 kg/m2, 35 to 49.9 kg/m2, greater than or equal to 50 kg/m2) and outcomes were compared. Multivariable logistic regression was used to evaluate the association between patient characteristics, surgical approach, and outcomes. An interaction term was used to evaluate the impact of BMI category on the risk associated with the surgical approach. RESULTS: A total of 27,006 patients underwent laparoscopic (18,610; 68.9%) or robotic (8,396; 31.1%) cholecystectomy. Robotic approach increased over time, with the greatest increase in patients with BMI greater than or equal to 50 kg/m2 (23.1% in 2020 vs 55.8% in 2024, p < 0.001). Compared with patients who underwent laparoscopic surgery, those who underwent robotic surgery were more likely to have a higher BMI (BMI 35 to 49.9 kg/m2: odds ratio [OR] 1.15, 95% CI 1.08 to 1.23, p < 0.001; BMI greater than equal to 50 kg/m2: OR 1.34, 95% CI 1.14 to 1.57, p < 0.001). BMI did not modify the effect of surgical approach on postoperative complication risk (BMI 35 to 49.9 kg/m2 with robotic approach: OR 0.97, 95% CI 0.60 to 1.56, p = 0.887; BMI greater than or equal to 50 kg/m2 with robotic approach OR 1.55, 95% CI 0.50 to 4.86, p = 0.451). CONCLUSIONS: Robotic approach is increasingly used in elective minimally invasive cholecystectomy, especially for patients with the highest BMI. Postoperative outcomes did not differ across BMI groups between robotic and laparoscopic cholecystectomy, indicating that BMI did not alter the relationship between surgical approach and outcomes.